Chronic critical illness in patients with acute respiratory failure admitted to a respiratory intensive care unit

Background: Chronic Critical Illness (CCI) is a condition associated to patients surviving an acute phase of disease although remaining dependent on mechanical ventilation (MV). The prevalence of CCI among patients with acute respiratory failure (ARF) undergoing MV and the underlying mechanisms have not been elucidated. Methods: We conducted an observational cohort study at our Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) from January 2014 to January 2016. Patients with ARF but without any advanced chronic lung disease undergoing MV were enrolled. We pre-specified the prevalence of CCI as the primary outcome; a sample size of 84 patients was analyzed. Diagnosis, clinical severity scores (APACHEII, SOFA, SAPSII, GCS) and conditions (septic shock, infections, ARDS) were recorded on admission. Inflammatory-metabolic blood parameters and their trends within the first days of stay were recorded. All these variables were tested as potential predictors of CCI. Results: CCI was identified in 37% of patients. APACHEII (RR= 2.1), SOFA (RR=1.8), SAPSII (RR=2.5), GCS (RR=2.6), septic shock (RR=15) and infections sustained by MDR bacteria (RR=6.8) were significantly associated with the development of CCI (p Conclusion: CCI is highly prevalent in patients with ARF admitted to a RICU. Severe infection and the persistence of inflammatory status are predictors of CCI development in this setting.